Abstract Introduction  The literature is scarce regarding the management of combined tears of scapholunate (SL) and lunotriquetral (LT) ligaments. This study aimed to evaluate our preliminary results with the arthroscopic dorsal ligamentocapsulodesis in managing such cases. Materials and Methods  Forty-two patients (13 females, 29 males; mean age = 31; age range = 18–51 years) who underwent arthroscopic dorsal ligamentocapsulodesis due to the combined tears of SL and LT ligaments were retrospectively reviewed. The mean follow-up was 38 (range = 24–55) months. The Modified Mayo Wrist Score, the visual analogue scale (VAS), and grip strength were assessed preoperatively and at the final follow-up examination. Results  The mean Modified Mayo Wrist Score significantly improved from 49 (range = 25–70) preoperatively to 82 (range = 60–100) at the final follow-up ( p  = 0.000). The mean VAS significantly decreased from 6.33 to 1.6 ( p  = 0.000). The mean hand grip strength significantly improved from 31 (range = 19–41) kg to 44 (range = 25–60) kg at the final follow-up examination ( p  < 0.001). No major complications were encountered. Conclusion  Arthroscopic dorsal ligamentocapsulodesis seems to be a safe and effective surgical technique in the management of this rare combined injury pattern. Level of Evidence  This is a Level IV, retrospective case series study.

Background: This study aimed to evaluate our preliminary results and experience with the arthroscopic dorsal ligamentocapsulodesis in managing occult dorsal wrist ganglion cysts (ODGCs) associated with scapholunate (SL) instability. Methods: All patients who underwent arthroscopic dorsal ligamentocapsulodesis due to an ODGC with concomitant SL ligament tear were retrospectively reviewed. In addition to demographic data and length of follow-up, outcomes data that included range of motion, grip strength, modified Mayo wrist score (MMWS), complications and radiographs were collected. Results: The study included 18 patients (18 wrists; 10 female and 8 male). The mean age was 32 years (range: 19–48) and the mean follow-up was 34 months (range: 24–48). The mean preoperative extension deficit decreased from 5.5° (range: 0°–20°) to 2.7° (range: 0°–15°) at the final follow-up (p = 0.004). The mean preoperative flexion deficits decreased from 4.4° (range: 0°–15°) to 2.2° (range: 0°–10°) postoperatively (p = 0.003). The mean hand grip strength significantly increased from 27.7 kg (range: 22–36) to 38.3 kg (range: 31–46) at the final follow-up assessment (p < 0.001). The mean MMWS improved from 46 (range: 25–65) pre-operatively to 91 (range: 70–100) at the final follow-up (p = 0.0002). No major intra- or postoperative complications were observed. Conclusions: SL instability may have an important role in the aetiology of ODGCs, and arthroscopic dorsal ligamentocapsulodesis can provide pain relief and functional improvement without recurrence at the short- to mid-term follow-up in the treatment of ODGCs. Level of Evidence: Level IV (Therapeutic)

Background: The literature is scarce regarding isolated tears of lunotriquetral interosseous ligament (LTIL). The purpose of this study was to present mid-term clinical and functional results of arthroscopic dorsal ligamentocapsulodesis in the treatment of isolated LTIL tears. Methods: Twenty-two patients (8 females, 14 males; mean age: 31 years; age range: 18-42) with isolated LTIL tears verified by wrist arthroscopy were retrospectively reviewed and included in the study. The mean follow-up was 55 months (range: 24-84). The modified Mayo wrist score, visual analog scale (VAS), flexion and extension deficits of passive wrist range of motion (ROM), pain-free ROM with forced wrist extension and grip strength were measured in all patients preoperatively and at final follow-up. Results: The mean modified Mayo wrist score significantly improved from 50 ± 10.29 preoperatively (range: 30-65) to 86 ± 11.61 (range: 60-100) at the final follow-up (p < 0.001). The mean VAS score significantly improved from 7.1 ± 0.83 (range: 6-8) preoperatively to 2.2 ± 1.35 (range: 0-6; p < 0.001) at the final follow-up. At the final follow-up examination, the forced wrist extension was painless in all but three patients who developed pain at 70º, 75º and 80º of extension, respectively. The mean strength of hand grip significantly increased from 38.6 ± 9.68 (range: 24-54) kg to 49.5 ± 12.36 (range: 33-66) kg at the final assessment (p < 0.001). No major complications were observed during or after the procedure. Conclusions: With the encouraging mid-term outcomes and a lower complication rate, arthroscopic LTIL dorsal ligamentocapsulodesis seems to be a safe and effective surgical technique in improving functional outcomes and reducing pain in patients with isolated LTIL tears. Level of Evidence: Level IV (Therapeutic).

BACKGROUND: The objective of the study is to compare the clinical results of the single-bundle (SB) and double-bundle (DB) anterior cruciate ligament (ACL) repairing techniques using magnetic resonance imaging (MRI). METHODS: Thirty-eight patients were randomized by block randomization into two different groups of ACL reconstruction: DB (n=19) and SB techniques (n=19). MRI evaluation and clinical examination with modified Cincinnati Knee Rating Score and Lysholm knee scores were performed pre-operatively and at the end of a follow-up period of 36 months. RESULTS: No significant differences were found in the ACL angle, posterior cruciate ligament angle, and tibial translation between the DB and the SB groups. Regarding the clinical scores, there were no significant differences between the techniques. As for the correlation of radiologic results with clinical scores in the SB group, there was a strong and significant correlation between the post-operative ACL angle values and the Lysholm clinical score (r=-0.66; p=0.002). CONCLUSION: The post-operative ACL angle can predict the degree of clinical recovery in patients undergoing SB ACL reconstruction.

Background Onychocryptosis, frequently termed ''ingrown toenail'' is a common foot problem in routine dermatology and orthopaedic clinical practice which leads to pain and disability. Although the aetiology of ingrown toenail is not well understood various associated risk factors have been identified with the pathogenesis. Material and methods This study was a retrospective investigation of 170 patients with hallux valgus and lateral border ingrown toenail of all stages. The patients were compared with a control group. The radiologic assessment in both groups included right hallux valgus angle, left hallux valgus angle, right first and second intermetatarsal angle, and left first and second intermetatarsal angle. Results There were 121 female and 49 male patients in the case group and 68 female and 32 male in the control group. The mean age of the case group was 41.1 years and 41.1 years in the control group. A statistically significant difference was found between the case and the control groups in terms of the right hallux valgus angle variable. Conclusion The abnormal hallux valgus angle and the abnormal intermetatarsal angle plays an important role in ingrown toenail aetiology. The X-rays of the feet should be performed to determine the susceptibility of the patients who are admitted to the hospital for ingrown toenail in order to prevent other toes ingrown toenail and for planning the treatment of the patients with an ingrown toenail.

Heparin-induced thrombocytopenia syndrome (HITS) is a rare complication of low-molecular-weight heparin (LMWH). It is an autoimmune-mediated side effect of LMWH which is caused by platelet-activating antibodies that recognize platelet factor-4/ heparin complexes. Although HITS often leads to thrombosis in large veins and arteries, it can be presented as microvascular thrombosis. In this article, we report a case of HITS complicated with multiple digital necrosis after administration of LMWH.

Background Degenerative arthritis of the first carpometacarpal (CMC) joint is a common degenerative condition in the hand. Many different surgical procedures have been applied for years. However, in the studies there is no consensus about the superiority of one technique to another. Questions/Purposes In this study, we evaluated the results of the patients with first CMC Eaton-Littler stage 2-3 arthrosis who were operated to prevent first metacarpal joint lateral subluxation and migration with arthroscopic hemitrapeziectomy and suture button suspensionplasty. Patients and Methods Between 2011 and 2014, 21 patients (16 female, five male) were evaluated retrospectively. Mean age was 52.3 years. The preoperative and postoperative assessments were performed with visual analog scale (VAS) and disabilities of the arm, shoulder, and hand score (DASH) scores. The Kapandji's thumb opposition score was used to assess thumb range of movement. The patients were assessed after arthroscopy according to Badia classification. Results Mean follow-up period was 50.1 months. According to Badia classification, seven patients were found to be type 2 and 14 patients were type 3. The mean preoperative Kapandji's score was 7.6 and the mean postoperative Kapandji's score was 9.2. The mean VAS values were 8.2 preoperatively and 1.9 postoperatively. The mean preoperative DASH value was 23.4 and the mean postoperative DASH value was 5.5. The mean preoperative grip strength was 66.2 and the mean postoperative grip strength was 75.1. The mean preoperative pinch strength was 14.8 and the mean postoperative pinch strength was 20.2. Conclusion Arthroscopic hemitrapeziectomy and suture button suspensionplasty is a minimal invasive technique and can be performed with low morbidity in the treatment of first CMC joint Eaton-Littler stage 2-3 arthrosis. By this technique, the patients' existing instability and pain problems can be solved. Complications, such as loosening of the suture button at the first metacarpal at the postoperative period due to direct trauma to the first CMC joint, could be avoided using a new suture button.

No consensus has been reached about the best treatment method of plantar fasciitis and the results of the treatment methods have been inconsistent. The objective of the present study was to compare the therapeutic effects of extracorporeal shock wave therapy, platelet-rich plasma injection, local corticosteroid injection, and prolotherapy for the treatment of chronic plantar fasciitis using a randomized, controlled, prospective study. We performed a randomized controlled prospective clinical study of 4 groups. The first group received extracorporeal shock wave therapy, the second group received prolotherapy, the third group received platelet-rich plasma injection, and the fourth group received a local corticosteroid injection. The study included 158 consecutive patients with a diagnosis of chronic plantar fasciitis with a symptomatic heel spur. The clinical outcomes were assessed using the visual analog scale and Revised Foot Function Index. At the end of the follow-up period, the mean visual analog scale scores for all 4 groups were similar to the mean visual analog scale scores before treatment. At the end of the follow-up period, no significant improvement was noted in the Revised Foot Function Index score in any of the groups. The corticosteroid injection was more effective in the first 3 months and extracorporeal shock wave therapy was an effective treatment method in the first 6 months in regard to pain. The corticosteroid injection lost its effectiveness during the follow-up period. The effect of prolotherapy and platelet-rich plasma was seen within 3 to 12 months; however, at the 36-month follow-up point, no differences were found among the 4 treatments.

BACKGROUND:Tibial torsion is rotation of the proximal versus the distal articular axis in the transverse plane. This study used computed tomography (CT) to examine rotational malalignment in the crus following use of minimally invasive plate osteosynthesis (MIPO) technique in distal tibial fractures and evaluated effect of rotational difference on clinical outcomes and VAS scores.METHODS:Analysis of 24 patients who were operated on for closed distal tibial fracture with MIPO technique between 2010 and 2012 was conducted. Malrotation was defined as rotational difference >10°. Operated knees were evaluated with 0.5-mm, fine-cut, 3-dimensional CT scan performed in cooperation with radiology department. Side-to-side difference in tibial torsion angle >10° was considered significant degree of malrotation. All patients were assessed clinically (visual analogue scale [VAS] and American Orthopaedic Foot and Ankle Society [AOFAS] scores) and radiologically at final visit.RESULTS:Mean follow-up period was 20.00±9.46 months (range: 18-51 months). Mean VAS score was 2.58±0.83 (range: 1-4) and mean AOFAS score was 87.50±4.05 (range: 78-93). Mean tibial rotation angle was 31.54±6.00° (range: 18-45°) on healthy side and 32.00±6.24° (range: 10-43°) on the operated side. No statistically significant difference was determined (p>0.05).CONCLUSION:Use of intraoperative fluoroscopy, cable technique, and uninjured extremity as reference, can reduce incidence of rotational malalignment of distal tibial fractures treated with MIPO.

We report a rare case of a "giant Baker's cyst-related rheumatoid arthritis (RA)" with 95 × 26 mm dimensions originating from the semimembranosus tendon. The patient presented with chronic pain and a palpable mass behind his left calf located between the posteriosuperior aspect of the popliteal fossa and the distal third of the calf. In MRI cystic lesion which was located in soft tissue at the posterior of gastrocnemius, extensive synovial pannus inside and degeneration of medial meniscus posterior horn were observed. Arthroscopic joint debridement and partial excision of the cyst via biomechanical valve excision were performed. The patient continued his follow-up visits at Rheumatology Department and there was no recurrence of cyst-related symptoms in 1-year follow-up. Similar cases were reported in the literature previously. However, as far as we know, a giant Baker's cyst-related RA, which was treated as described, has not yet been presented.

BACKGROUND:The aim of this prospective randomized study was to compare the traction table and lateral decubitus position techniques in the management of unstable intertrochanteric fractures. METHODS:Eighty-two patients with unstable intertrochanteric fractures between 2011 and 2013 were included in this study. All patients were treated surgically with the Proximal Femoral Nail Antirotation implant (DePuy Synthes). Patients were randomized to undergo the procedure in the lateral decubitus position (42 patients) or with the use of a traction table (40 patients). Patients whose procedure was not performed entirely with a semi-invasive method or who required the use of additional fixation materials, such as cables, were excluded from the study. The groups were compared on the basis of the setup time, surgical time, fluoroscopic exposure time, tip-to-apex distance, collodiaphyseal angle, and modified Baumgaertner criteria for radiologic reduction. RESULTS:The setup time, surgical time, and fluoroscopic exposure time were lower and the differences were statistically significant in the lateral decubitus group compared with the traction table group. The collodiaphyseal angles were significantly different between the groups in favor of the lateral decubitus method. The tip-to-apex distance and the classification of reduction according to the modified Baumgaertner criteria did not demonstrate a statistically significant difference between the groups. CONCLUSIONS:The lateral decubitus position is used for most open procedures of the hip. We found that this position facilitates exposure for the surgical treatment of unstable intertrochanteric fractures and has advantages over the traction table in terms of set up time, surgical time and fluoroscopic exposure time.

Date of acceptance / Kabul tarihi: March 15, 2016 / 15 Mart 2016 ABSTRACT: Symphysis pubis diastasis after difficult birth: a case report Objective: Symphysis pubis diastasis is an uncommon peripartum complication that might result in a serious distress to the patient. With pregnancy, the gap increases by at least 2 to 3 mm, which is thought to be caused by the slackness of ligaments supporting the joint. The diagnosis of diastasis is based on the persistence of symptoms and a symphysis pubis separation of more than 10 to 13 mm on imaging. Case report: We report a 34-year-old multigravida woman with gestational diabetes at nearly 40 weeks of gestation and is presented with a spontaneous onset of pelvic pain, difficulty in walking after a shoulder distosi labor and diagnosed symphysis pubis diastasis. Conclusion: After child birth if there is increasing pain with hip movement and pain causing prolonged immobilization, symphysis pubis diastase should be suspected and further investigation is recommended.

Displaced intra-articular calcaneal fractures are difficult to treat. We determined the functional results and complications of using allografts or equine xenografts in treating these fractures. We reviewed patients seen at our center from May 2011 to December 2014 with Sanders type III or IV unilateral calcaneal fractures treated with locking plates and an additional bone allograft or equine xenograft. A minimum of 1 year after surgery, a history of infection and functional outcomes were assessed using the American Orthopaedic Foot and Ankle Society clinical rating system. Changes in the Gissane angle (GA) and Böhler angle were assessed from radiographs. Of the 91 eligible patients, 15 were lost to follow-up, leaving a sample of 76 patients (42 males): 45 received allografts (19 for type III and 26 for type IV fractures) and 31 received xenografts (20 for type III and 11 for type IV fractures). The mean age was about 40 years in both groups. After ≥1 year of follow-up, the proportion of patients in the American Orthopaedic Foot and Ankle Society scoring categories did not differ significantly between the 2 groups (mean ankle score, 86.5 in the allograft group and 85.1 in the xenograft group), and the American Orthopaedic Foot and Ankle Society functional outcomes were good or excellent in 69% and 68%, respectively (p = .986). The groups did not differ in the incidence of superficial or deep infection (p = 1.000). The Böhler angles were significantly decreased in the xenograft group. Xenografts might be preferred for repairing intra-articular calcaneal fractures because they can perform as well as allografts, avoid donor site morbidities, and are more available and less expensive than allografts.

Objectives: We aimed to evaluate the safety and outcomes of plate-screw fixation used for the immediate treatment of type-IIIC open fractures of forearm bones with complex soft tissue injuries. Methods: A total of 22 patients (mean age: 31.6, range: 24-60) treated between 2004-2010 were retrospectively analyzed. All injuries resulted from high-energy traumas and fractures were classified using AO classification. All patients had vascular and nerve injuries, and four had skin defects associated with double fractures of the forearm. All patients were operated on within the first eight hours following injury. Six patients with comminuted fractures or with bone defects underwent primary bone grafting, and one patient was treated with shortening. Primary skin closure was achieved in 17 patients and three patients underwent immediate repair using skin grafts, while two patients were repaired with immediate transposition flaps. Bony unions, complications, and functional results via a DASH questionnaire were investigated. Results: Mean follow-up was 28 months (range: 14-70). In all patients, radius bone union was achieved. Two patients underwent a Sauve-Kapandji procedure, utilizing the fractured segment of the ulnar diaphysis as a graft for radius. In one patient, osteosynthesis was repeated after 6 months because of nonunion. Mean period to bony union was 4.59 months (range: 3-6). Superficial infection developed in three patients after the operation, and was resolved with antibiotic therapy. The mean DASH score after surgery was 25.6. Conclusion: In high nergy traumas of the upper extremity associated with complex injuries and Type-IIIC forearm fractures, severity of soft tissue injuries determined the functional results in patients, demonstrating it is possible to achieve a safe and efficient fixation with immediate plate-screw osteosynthesis.

This report presents the case of a 51-year-old woman with intermittent left knee pain, especially during full flexion of the knee, which had been ongoing for 1 year. Magnetic resonance imaging (MRI) showed mild effusion and round mass at the posterior compartment without synovial changes. Computerized tomography (CT) indicated mass had homogeneous low attenuation and density measurement of -99.4±62.3 Hounsfield units (HU), correlated with a lipomatous lesion.

OBJECTIVE:The aim of the present study was to assess results of rehabilitation of patients after finger replantation. METHODS:The study examined 160 fingers amputated and replanted at various levels between 2000 and 2013 at the clinic.Mean patient age was 29.4 years.Mean follow-up time was 23 months.Rehabilitation of fingers began between postoperative fourth and eighth week and continued until the 24th week.Range of motion of affected hand, return to daily activities, aesthetic appearance, and patient satisfaction were assessed according to Tamai criteria. RESULTS:Functional results according to Tamai criteria were perfect in 36 patients, good in 54 patients, average in 27 patients, and poor in 18 patients. CONCLUSION:Post-operative rehabilitation of replanted fingers should begin as soon as possible.During the rehabilitation period, physiotherapist, surgeon, and patient must work in close cooperation.Functional results of patients who adjust to the rehabilitation program, home practice, and splint usage are better.

Background: Nail bed deformity and tumor recurrence are the major complications of subungual glomus tumor surgery. Therefore, alternative methods to approach glomus tumors in the hand have been proposed in order to avoid further nail bed injury after surgical treatment. Methods: In this study, we report a series of 32 patients with glomus tumors in the subungual region of the hand, treated surgically with two different types of incisions. The clinical efficacy and safety of the surgical treatment of glomus tumors performed by the lateral subperiosteal or the transungual approaches were analyzed. Results: In transungual approach since the nail plate is extracted and the nail bed is incised, there is a high risk of postoperative nail deformity and late recovery. However, in lateral subperiosteal approach since only the skin lateral to the nail is incised without extracting nail plate and incising nail bed, the nail bed injury does not occur. Conclusion: As a result, early recovery occurs and postoperative nail deformity is unaccepted. The main advantages of lateral subperiosteal approach are reducing postoperative nail deformity and early recovery. However, not every glomus tumor is suitable for lateral subperiosteal approach. In peripherally located tumors, the lateral subperiosteal approach provides quick recovery of the cosmetic appearance and less deformation of the nail.

Aim: Glomus tumors are typically located in the subungual region in 75%-90% of patients. However, these tumors can be seen in atypical localizations which are extra-digital parts of the human body. Here, we present the management of a series of five patients with extra-digital glomus tumors treated surgically. Patients and methods: The mean age of the patients was 40.6 years. The mean duration between symptom onset and presentation was 3.6 years. The localization of the tumors were anterolaterally of the thigh, posteriorly of the humerus lateral condyle, posteriorly of the humerus supracondylar region, anteromedially of the tuberositas tibia, and on the dorsal side of the wrist. Results: The mean follow-up was at 52.8 months. For all patients, all lesions healed without any wound issues and no recurrences were noted during the follow-up period. Conclusion: When a painful mass is found in the body, glomus tumors should be kept in mind. The consideration of symptoms, including pain, temperature sensitivity, point tenderness, and discoloration, common characteristics of glomus tumors, may aid diagnosis.

Background: The aim of the present study is to compare the clinical efficacy and safety of two different vacuum-assisted closure (VAC) applications in one center between two groups of patients with Wagner Grade 3-4 multiple chronic diabetic foot wounds.Methods: The study was a randomized-controlled, prospective investigation between two groups of patients with Wagner Grade 3-4 multiple chronic diabetic foot wounds at single extremity. There were 10 patients in the first group receiving VAC treatment by means of Y-connector and 11 patients in the second group receiving bridge-VAC treatment.Results: There were no significant difference in Revised Foot Function Index scores and total treatment costs between the both groups. The cost of the VAC dressing supplies in one session of the dressings was lower in the bridge-VAC group.Conclusions: In conclusion, although bridge-VAC treatment seems to be an alternative method to the VAC treatment by means of Y-connector, we found no superiority of one over the other VAC application for chronic diabetic foot wounds. (C) 2016 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.